Provider Demographics
NPI:1588117030
Name:CASH- HARRIS, ANNIE MARY
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:MARY
Last Name:CASH- HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 N BURNSIDE AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-2157
Mailing Address - Country:US
Mailing Address - Phone:225-644-8565
Mailing Address - Fax:225-644-6261
Practice Address - Street 1:1724 N BURNSIDE AVE STE 7
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-2157
Practice Address - Country:US
Practice Address - Phone:225-644-8565
Practice Address - Fax:225-644-6261
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10540251B00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251B00000XAgenciesCase Management